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* From the Sections of Pediatric Pulmonology (Drs. Bandla, Beckerman, and Gozal) and Critical Care (Dr. Hopkins), Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA.
Correspondence to: David Gozal, MD, FCCP, Section of Pediatric Pulmonology, Department of Pediatrics, Tulane University School of Medicine, SL-37, 1430 Tulane Ave, New Orleans, LA 70112; e-mail: dgozal{at}tmcpop.tmc.tulane.edu
Study objectives: To identify pulmonary risk factors
associated with prolonged ICU stay in young children (
2 years)
undergoing surgical repair for congenital heart disease (CHD).
Design: Retrospective case series analysis.
Setting: Tertiary-care facility.
Patients:
Clinical records of 134 consecutive patients aged 2 years
undergoing cardiac surgery for CHD were reviewed, and 37 were excluded
according to inclusion criteria. Thus, 97 patients were allocated to
two groups based on the duration of ICU stay: 7 days (group 1,
n = 57), and > 7 days (group 2, n = 40).
Results: Mean ICU duration for groups 1 and 2 was 3.0 ± 0.4 days and 28.1 ± 4.4 days, respectively (p < 0.001). In group 1, there were three extubation failures, whereas 41 extubation failures occurred in group 2 (p < 0.0001). A total of 22 patients (4 in group 1 and 18 in group 2) developed noninfectious pulmonary complications, such as airway problems, including extrinsic airway compression and tracheobronchomalacia (n = 6); pulmonary hypertension (n = 5); phrenic nerve palsy (n = 7); and pleural effusion (n = 8). These 22 patients (23%) contributed to the majority of total ventilator days (67%) as well as ICU stay (61%).
Conclusions: Pulmonary complications in general, and central airway problems in particular, are a frequent cause for delayed recovery following cardiac surgery in young children.
Key Words: cardiac surgery • congenital heart disease • flexible bronchoscopy • intensive care • mechanical ventilation • phrenic nerve palsy • respiratory morbidity • tracheobronchomalacia
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